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SonoCase: 72 yr old, woke up with “funny” vision… What’s up with that eye?!

One of my good friends and colleagues, Dr. Graham Walker, emailed me the other day with a “booya, check it out”-type of email that he knows I love and cherish. He made the diagnosis quickly with the help of his bedside US study.

72 year old male with a history of hypertension, high cholesterol and on antibiotics for a foot infection – – stating he woke up and his vision was “funny” – had part of his left eye vision gone with a large circle of yellow around what he could see, without prior trauma, pain or discharge. His external eye exam was normal, visual acuity 20/50 bilaterally, and neuro exam normal. The working diagnoses came down to 2 things, both of which we can ‘see’ on bedside US (pun absolutely intended): vitreous hemorrhage, retinal detachment. Below is his bedside ultrasound study:

So, he correctly saw an abnormality in the above vitreous (posterior) chamber which normally should be anechoic without echoes as it is filled with fluid – See below for normal eye:

But, as he was fanning through the eye with the linear transducer, he saw a linear echo coming off from the retina (which attaches posteriorly on the eyeball on the screen). This is a retinal detachment. Graham called ophtho and the patient was taken care of quickly.

If your suspicion is high and you are having a hard time seeing if there are echoes within the posterior chamber, increase the GAIN – make it more bright – that retinal detachment will be much more obvious to you. See below for an example of that:

Below is an example of a traumatic retinal detachment as well as globe rupture (you can appreciate the loss of the normal circular appearance of the orbit as well as loss of the anterior chamber).